6A BECKET ST - BPA-2006-1025 WINDOWS .pLA"S1M jSfigEfllfg--A*0.APPROVED BY T44E
JAISPECIrttA PMgR TD.A.PEAIWT f3,EING GRANTED
CITY OF SALEM
O � %• � Date �
No.L/� �c
s:y s1
Is Property Located inLocation of
the Hlatoric District? Yes No_ Bui.ldinB
is Pmperty Located In
no Conservatbn Area? Yes,_No v
BUILDING PERMIT APPLICATION FOR:
Permit to: Construct Deck, Shed, Pool,
Siding, Con
(Circle whichever apply) Roof nstall g,
epair/Replace, they:
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name �Dn
Address & Phone
Architect's Name
Address & Phone
Mechanics Name
Address & Phone
4183Z
Whet Is the purpose of building?
AAdeft of ? If a dwaYing,for how many femtlles?
WW Wlang cordonn to law? Asbestos?
Eatlrnetad coat 15 - °� GN Ucense r N �` Cign2ature
a �3 9
Rona Iaptover.ent
Lie. 0Z �� of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
No. / 6
APPLICATION FOR
PERMIT TO
LOCATION,
PERMIT GRANTED
20
AP tV�D
INSPECTO F BUILDINGS